Department of Neurosurgery, Bergman Clinics, Amsterdam, The Netherlands; Faculty of Medicine, University of Zurich, Zurich, Switzerland.
Department of Neurosurgery, Bergman Clinics, Amsterdam, The Netherlands; School of Medicine, University of Nottingham, Nottingham, United Kingdom.
World Neurosurg. 2019 Jul;127:576-587.e5. doi: 10.1016/j.wneu.2019.03.196. Epub 2019 Apr 4.
Robotic guidance (RG) and navigation (NV) have been shown to reduce radiologic and clinically relevant pedicle screw malpositions. It remains unknown if there are any additional benefits to these techniques in intraoperative and perioperative end points.
We conducted a systematic review in MEDLINE, Embase, Scopus, and the Cochrane Library and identified controlled studies comparing RG, NV, and freehand (FH) thoracolumbar pedicle screw insertion and carried out random-effects meta-analyses.
Thirty-two studies (24,008 patients) were included. Only 8 studies (26%) were randomized, and study quality was rated as very low or low in 24 cases (77%). Compared with NV, FH procedures showed longer length of hospital stay (Δ, 0.7 days; 95% confidence interval, 0.2-1.2; P = 0.006) and more overall complications (odds ratio, 1.6; 95% confidence interval, 1.3-1.9; P < 0.001). No statistically significant differences among RG and FH were identified, likely because of lack in statistical power (all P > 0.05). In particular, both RG and NV did not show increased intraoperative radiation use, as determined by seconds of fluoroscopy, compared with FH (both P > 0.05).
It seems that navigation may offer potential benefits in perioperative outcomes such as length of hospital stay and overall complications, without significant increase in intraoperative radiation, which cannot yet be said for robotic guidance. The findings must be interpreted with caution, because the evidence is severely limited in both quantity and quality. Further evaluation will establish any demonstrable intraoperative or perioperative benefits to computer assistance, which may warrant the high costs often associated with these devices.
机器人引导（RG）和导航（NV）已被证明可减少放射学和临床相关的椎弓根螺钉位置不当。尚不清楚这些技术在术中及围手术期终点是否有其他益处。
我们在 MEDLINE、Embase、Scopus 和 Cochrane 图书馆中进行了系统评价，确定了比较 RG、NV 和徒手（FH）胸腰椎椎弓根螺钉插入的对照研究，并进行了随机效应荟萃分析。
共纳入 32 项研究（24008 例患者）。只有 8 项研究（26%）是随机的，24 项研究（77%）的研究质量被评为非常低或低。与 NV 相比，FH 手术的住院时间更长（差值，0.7 天；95%置信区间，0.2-1.2；P=0.006），总并发症更多（比值比，1.6；95%置信区间，1.3-1.9；P<0.001）。RG 和 FH 之间没有统计学差异，可能是因为缺乏统计学效力（所有 P>0.05）。特别是，与 FH 相比，RG 和 NV 都没有增加术中辐射的使用，以透视秒数来衡量（两者均 P>0.05）。
导航可能在围手术期结果（如住院时间和总并发症）方面具有潜在益处，而不会显著增加术中辐射，这一点目前还不能说对机器人引导是如此。由于数量和质量都受到严重限制，因此必须谨慎解释这些发现。进一步的评估将确定计算机辅助是否具有任何可证明的术中或围手术期益处，这可能证明这些设备通常相关的高成本是合理的。
